TY - JOUR
T1 - Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome
AU - Teede, Helena J.
AU - Tay, Chau Thien
AU - Laven, Joop J.E.
AU - Dokras, Anuja
AU - Moran, Lisa J.
AU - Piltonen, Terhi T.
AU - Costello, Michael F.
AU - Boivin, Jacky
AU - Redman, Leanne M.
AU - Boyle, Jacqueline A.
AU - Norman, Robert J.
AU - Mousa, Aya
AU - Joham, Anju E.
AU - the International PCOS Network
AU - Arlt, Wiebke
AU - Azziz, Ricardo
AU - Balen, Adam
AU - Bedson, Lisa
AU - Berry, Lorna
AU - Brennan, Leah
AU - Brown, Wendy
AU - Burgert, Tania
AU - Busby, Maureen
AU - Ee, Carolyn
AU - Garad, Rhonda M.
AU - Gibson-Helm, Melanie
AU - Harrison, Cheryce
AU - Hart, Roger
AU - Hopkins, Kim
AU - Hirschberg, Angelica Lindén
AU - Ho, Tuong
AU - Hoeger, Kathleen
AU - Jordan, Cailin
AU - Legro, Richard S.
AU - Li, Rong
AU - Lujan, Marla
AU - Ma, Ronald
AU - Mansfield, Darren
AU - Marsh, Kate
AU - Mocanu, Edgar
AU - Mol, Ben
AU - Mormon, Rachel
AU - Norman, Robert
AU - Oberfield, Sharon
AU - Patel, Malika
AU - Pattuwage, Loyal
AU - Peña, Alexia
AU - Redman, Leanne
AU - Rombauts, Luk
AU - Romualdi, Daniela
AU - Shah, Duru
AU - Spritzer, Poli Mara
AU - Stener-Victorin, Elisabet
AU - Tehrani, Fahimeh Ramezani
AU - Thangaratinam, Shakila
AU - Thondan, Mala
AU - Vanky, Eszter
AU - Wijeyaratne, Chandrika
AU - Witchel, Selma
AU - Yang, Dongzi
AU - Yildiz, Bulent
AU - Alesi, Simon
AU - Alur-Gupta, Snigdha
AU - Avery, Jodie
AU - Khomami, Mahnaz Bahri
AU - Benham, Jamie
AU - Bidstrup, Hugh
AU - Chua, Su Jen
AU - Cooney, Laura
AU - Coster, Thisara
AU - Fitz, Victoria
AU - Flanagan, Madeline
AU - Forslund, Maria
AU - Jiskoot, Geranne
AU - Kazemi, Maryam
AU - Kempegowda, Punith
AU - Louwers, Yvonne
AU - Melin, Johanna
AU - Melson, Eka
AU - Mengistu, Yitayeh Belsti
AU - Naderpoor, Negar
AU - Neven, Adriana
AU - Pastoor, Hester
AU - Rocha, Thais
AU - Sabag, Angelo
AU - Subramanian, Anuradhaa
AU - Tan, Katrina
PY - 2023/8
Y1 - 2023/8
N2 - Study question: What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary answer: International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. What is known already: The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from 6 continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low-to low-quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus-based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, the evidence quality was low, and evidence-practice gaps persist. Study design, size, and duration: The 2023 International Evidence-based Guideline update re-engaged the 2018 network across professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength, and diversity and inclusion were considered throughout. Participants/materials, setting, and methods: This summary should be read in conjunction with the full guideline for detailed participants and methods. Governance included a 6-continent international advisory and management committee, 5 guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health, and other experts, alongside consumers, project management, evidence synthesis, statisticians, and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and 5 face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across 5 guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council. Main results and the role of chance: The evidence in the assessment and management of PCOS has generally improved in the past 5 years but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include the following: (1) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm, and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only; (2) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnoea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; (3) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care, and shared decision-making to improve patient experience, alongside greater research; (4) maintained emphasis on healthy lifestyle, emotional well-being, and quality of life, with awareness and consideration of weight stigma; and (5) emphasizing evidence-based medical therapy and cheaper and safer fertility management. Limitations and reasons for caution: Overall, recommendations are strengthened and evidence is improved but remains generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. Wider implications of the findings: The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input, and consumer preferences. Research recommendations have been generated, and a comprehensive multifaceted dissemination and translation programme supports the guideline with an integrated evaluation programme.
AB - Study question: What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary answer: International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. What is known already: The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from 6 continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low-to low-quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus-based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, the evidence quality was low, and evidence-practice gaps persist. Study design, size, and duration: The 2023 International Evidence-based Guideline update re-engaged the 2018 network across professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength, and diversity and inclusion were considered throughout. Participants/materials, setting, and methods: This summary should be read in conjunction with the full guideline for detailed participants and methods. Governance included a 6-continent international advisory and management committee, 5 guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health, and other experts, alongside consumers, project management, evidence synthesis, statisticians, and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and 5 face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across 5 guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council. Main results and the role of chance: The evidence in the assessment and management of PCOS has generally improved in the past 5 years but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include the following: (1) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm, and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only; (2) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnoea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; (3) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care, and shared decision-making to improve patient experience, alongside greater research; (4) maintained emphasis on healthy lifestyle, emotional well-being, and quality of life, with awareness and consideration of weight stigma; and (5) emphasizing evidence-based medical therapy and cheaper and safer fertility management. Limitations and reasons for caution: Overall, recommendations are strengthened and evidence is improved but remains generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. Wider implications of the findings: The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input, and consumer preferences. Research recommendations have been generated, and a comprehensive multifaceted dissemination and translation programme supports the guideline with an integrated evaluation programme.
KW - assessment
KW - evidence based
KW - GRADE
KW - guideline
KW - management
KW - polycystic ovary syndrome
UR - http://www.scopus.com/inward/record.url?scp=85169847800&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1171592
U2 - 10.1093/ejendo/lvad096
DO - 10.1093/ejendo/lvad096
M3 - Article
C2 - 37580861
AN - SCOPUS:85169847800
SN - 0804-4643
VL - 189
SP - G43-G64
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 2
ER -